Other methods. In addition, the following methods of treatment have been suggested. Although many failures have occurred in proportion to the few successful cases published, yet they show the possibility that something can be done by operative measures, and that considerable advance has been made in recent years in this direction.
(i) Repeated lumbar puncture. In a few cases of serous meningitis this has proved successful in that it has relieved intracranial pressure. It is, however, only of value if free communication still exists between the spinal theca and subarachnoid space.
(ii) Continuous drainage from the spinal canal. Friedrich, of Kiel, has suggested a counter-opening in the spinal canal by means of laminectomy in order to permit of drainage of the entire dural sac.
(iii) Puncture of the lateral ventricle. The temporo-sphenoidal lobe is pierced with a trocar, just above the zygomatic ridge, until the ventricle is reached; this has been performed frequently in order to relieve intracranial pressure. I know of only one recorded instance in which recovery has taken place in spite of there being pyogenic infection of the lateral ventricle; a fact which was proved by tapping the ventricle and removing from it a drachm and a half of purulent fluid (Archives of Otology, vol. xxxv, p. 535).
(iv) Drainage through the internal ear. West and Scott have recently described a case of meningitis which occurred after having curetted the inner wall of the tympanic cavity. They then opened up the labyrinth and inserted a wire drain through the internal auditory meatus, at the same time making a counter-opening in the lumbar region, through which they drained the spinal canal. The patient, a child, ultimately recovered.
Prognosis and after-results. Unless saved by operation, meningitis is almost uniformly fatal. Even if the patient recovers, whether as the result of operation or not, deaf-mutism or mental deficiency frequently occurs. In a few cases, however, complete recovery has taken place.
CHAPTER IX
OPERATIONS FOR LATERAL SINUS THROMBOSIS
OF OTITIC ORIGIN
GENERAL CONSIDERATIONS
The sigmoid portion of the lateral sinus is the part usually infected. Thrombosis, however, may occur primarily in the region of the jugular bulb from direct extension of the pyogenic infection through the floor of the tympanic cavity; this, though less frequent than involvement of the sigmoid sinus, is not so rare as has hitherto been supposed.